Forestbrook Middle School

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Mr. Sylvester Carr, 8th Grade AP Mrs. Ashley Rhodes, 8th Grade School Counselor
Dr. Beverly McCain, 7th Grade AP Ms. Amy Ayers, 7th Grade School Counselor
Mrs. Olga Toggas, 6th Grade AP Ms. Mallie Baker, 6th Grade School Counselor
Ms. Kayla Maxwell, Curriculum Coach Mrs. Shonda Owens-McKnight, School Counselor
Mrs. Beth Welch, Curriculum Coach Mrs. Susan Volpe, School Counselor

Mrs. Beverly Holt-Pilkey

Palmettos Finest Award Winning School

National Blue Ribbon School

Forestbrook Middle School Crisis Report

Date:_________________

Incident: ___________________________________________________________________________________________

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Recommendation: ____________________________________________________________________________________

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_____Waiver of Liability: In reference to the above incident, I have read and understand the recommendation by
Forestbrook Middle School and understand that if I decide not to follow this recommendation, I will not hold
Forestbrook Middle School or Horry County Schools liable for any future actions associated with the above incident.

____Waiver of Medical Costs: In reference to the above incident, I understand that Forestbrook Middle School or
Horry County Schools will not be held responsible for any costs associated with treatment regarding my student.

Parent Signature:_____________________________________________________________________________________

School Personnel: ____________________________________________________________________________________

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Date of Re-Entry:___________ Notes: __________________________________

Actions Taken:
Doctor or Counselors Note/Release _________________________________________
Appointment Scheduled
Parent Conference ___________________________________
Other
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A Tradition of Excellence
4430 Gator Lane Myrtle Beach, SC 29588
(843) 236-7300 Phone
(843) 236-8065 Fax
School Website: http://fm.horrycountyschools.net/